Effect Of Varying Alcohol Dosing In Percutaneous Transluminal Septal Myocardial Ablation For Hypertrophic Obstructive Cardiomyopathy:A Meta Analysis

ObjectiveIn order to evaluate the different of the clinical effect and safty between low alcohol and high alcohol in the percutaneous transluminal septal myocardial ablation,we performed the meta analysis about the research of treatment of patients with hypertrophic obstructive cardiomyopathy(HOCM).Providing evidence-based medical evidence for the choice of alcohol dose in the percutaneous transluminal septal myocardial ablation.MethodThe datebase including Pubmed,Embase,Cochrane library,CNKI,WANGFANG,VIP should be Searched by the website after established literature inclusion criteri a.Except of using the method of combinated the keywords with the free words,We used the retrieve strategy of retrospect.All of the material about theresearches should be collected from the time when the datebase established to February 2018.Then we used the software of RevMan5.2 to accomplish the meta analysis.ResultBased the literature inclusion criteria,302 literatures had be enrolled in total.In the last,4 literatures was qualified.All of The 4 literatures is randomized controlled trial.The quality assesment score of the 4 literatures is four.The result of the meta analysis identified,there was no significant statistics differences in the validity index between the low dose alcohol group and high dose alcohol group.In the follow-up time,the left ventricular outflow tract gradient(LVOTG)(WMD=1.58,95%CI[-4.27,7.43],P=0.60),the interventricular septal thickness(IVS)(WMD=0.53,95%CI[-0.55,1.61],P=0.33),the left ventricular diastole diameter(LVd)(WMD=-0.50,95%CI[-1.86,-0.85],P<0.47),the left ventricular ejection fraction(LVEF)(WMD=1.99,95%CI[-0.09,4.08],P=0.06),the New York Heart Association class(NYHA分级)(WMD=0.22,95%CI[0.00,0.44],P=0.05),the Canadian Cardiovascular Society class(CCS分级)(WMD=0.16,95%CI[-0.12,0.45],P=0.26),was no significant statistics differences between the low dose alcohol group and high dose alcohol group.When it comes to the safty of the alcohol septal ablation,there was significant statistics differences in the detect of the postoperative creatine kinase(CK-MB)level between the low dose alcohol group and high dose alcohol group(WMD=-0.82,95%CI[-1.19,-0.44],P<0.0001).Except that,the permanent pacemake implantation(RR=1.69,95%CI[0.64,4.49],P=0.29),the branch block(RR=0.91,95%CI[0.67,1.24],P=0.56),ventricula rarrhythmia(RR=1.02,95%CI[0.31,3.36],P=0.98),was no significant statistics differences between the low dose alcohol group and high dose alcohol group.ConclusionIn the operation of the percutaneous transluminal septal myocardial ablation in treat hypertrophic obstructive cardiomyopathy(HOCM),when the alcohol dose we injected is 1-4milliliter,the low dose group and the high dose group has the same effects.But the low dose alcohol group can achieve the same target without increase the myocardial infarct size.In the other hand,the high alcohol group increase the myocardial infarct size,it seemed to rusult in the higher operative complications.In a word,in the operation of alcohol septal ablation we should used the alcohol dose as lower as possible,when it permited.